Care planning: mapping achievable goals   1

 Care planning: mapping achievable goals
1
The care planning manual: mapping achievable goals
A collaborative, mapping-based intervention for helping keyworkers and clients identify
effective treatment goals.
Authors: E. Day and D. Best, University of Birmingham; N.G. Bartholomew, D.F.
Dansereau, and D.D. Simpson, Texas Institute of Behavioural Research at TCU March 2008
Treatment effectiveness initiatives
The National Treatment Agency’s treatment effectiveness strategy (NTA, 2005) was
launched in June 2005. It incorporates mechanisms and initiatives to improve the
effectiveness of drug treatment, in line with the Government’s National Drug Strategy
objectives. The strategy identifies treatment engagement and delivery as areas where
the quality of interventions could be improved. Effective care planning is proposed as
one mechanism by which treatment quality can be both improved and measured.
This project is a collaboration between the NTA, Texas Institute of Behavioral Research
(IBR at Texas Christian University) and The University of Birmingham. It proposes a
method of care planning that builds on an evidence-based model of service
improvement adapted for use in England. The model is summarised in Simpson (2004)
and the IBR publication ‘Research Roundup’ (Fall-Winter 2004/05) Volume 14 (see
www.ibr.tcu.edu).
¨
A wide variety of node-link mapping materials are available as Adobe PDF files for free,
easy downloads at www.ibr.tcu.edu
This manual is an adaptation of material first produced by TCU Institute of Behavioral Research
(www.ibr.tcu.edu) , together with new material developed at the University of Birmingham. TCU has
granted the University of Birmingham permission to adapt their material for the purpose of producing and
publishing this manual.
Copyright © The University of Birmingham 2008
All rights reserved. Except as otherwise permitted under the Copyright Designs and Patents Act 1988, no
part of the work may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the
University of Birmingham. Enquiries concerning reproduction outside these terms should be sent to The
University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Birmingham B15 2QZ
2
Introduction: Background to care planning and node-link mapping ................................... 3
Background and rationale for using node-link mapping for enhancing
engagement in treatment and care planning
Session 1: Using node-link maps to enhance assessment ................................................... 11
Keyworker guide for using maps to explore client’s history and current concerns as
a foundation for setting future goals
Session 2: Developing an effective care plan ...................................................................... 19
Keyworker guide for using maps to engage clients in establishing useful and
workable goals for leaving treatment and aftercare
Session 3: Mapping progress & future plans ....................................................................... 28
Keyworker guide for using maps to help client monitor progress in achieving goals
Appendix 1: The research evidence for mapping ................................................................ 37
Bibliography of mapping research studies
Appendix 2: Extra guide maps for enhancing assessment .................................................. 41
Appendix 3: Worked example............................................................................................... 47
© Copyright 2008 The University of Birmingham, UK. All rights reserved.
Acknowledgements
The materials in this manual have evolved with continued use and refinement by Birmingham clinicians. We
are grateful for contributions from Paul McTague, Angela Little, and Fiona Connolly.
3
Introduction
Background to care planning and node-link mapping
This section introduces the basics of node-link mapping, the use of structured maps for
assessment and care planning, and the use of feedback from a dynamic assessment of
client progress to help guide planning. This approach highlights the importance of
developing the keyworker-client relationship through collaboration.
The importance of care planning
Care planning is a core requirement of structured treatment in England, as defined by
the NTA’s Care Planning Practice Guide (see www.nta.nhs.uk). Care planning is the
process of setting goals and interventions based on the needs identified by an
assessment and then planning how to achieve those goals with the client.
Although having a formal care plan for each client is an NTA requirement, little
attention has been paid to how care plans are developed, and there is a danger that
they become an administrative document that feels like a burden for both keyworker
and client. In some cases, care plans are generated in a standardized manner and then
filed away, primarily so that future auditors can note programme compliance.
Keyworkers working with clients may not even refer to these plans or refer to them only
in generalities (ie, “Mary needs to work on her job skills”).
The process described in this manual goes some way towards turning the process of
Care Planning into an effective intervention in its own right. There are a number of key
features to the process described:
•
Using a node-link mapping technique, the client is encouraged to consider all
the potential problem areas in their life, and prioritise the ones that are
important to them (even if these don’t relate to drug or alcohol use). This
ensures that the whole process is collaborative, and involves joint input from
worker and client
•
The keyworker helps the client to set specific, realistic and time-limited goals,
which are then reviewed on each visit to the treatment centre. This gives the
whole treatment episode a structure, on which other interventions can be built.
This manual assumes that keyworking is an essential part of effective treatment of drug
problems. However, it also acknowledges that keyworkers have a range of abilities in
delivering therapeutic interventions. It therefore aims to equip treatment staff with a
basic method of interacting with clients, which can then be supplemented by a range of
other interventions depending on client need and staff competence and confidence. It
forms part of a wider treatment process model (see www.ibr.tcu.edu), which includes a
range of short, focused interventions that have node-link mapping as a common
structure. Research evidence shows that using such node-link mapping techniques, it is
possible to improve engagement in treatment and therapeutic alliance, and enhance
problem solving skills.
The manual doesn’t assume any high level academic knowledge, or experience or
training in a psychological intervention. However, clinical supervision of the process is
4
enhanced by the use of node-link maps, which can be copied and kept in the clinical
file. The tools presented here are flexible, and can be used in conjunction with existing
paperwork. Alternatively these maps can be adapted to suit the needs of the keyworker
and their clients.
What is node-link mapping?
We often use maps from a road atlas to find out where we are, to work out how to go
from place to place, and to give directions to other people. As well as showing how
cities, towns, lakes and shopping centres are connected to one another, visual maps can
also show how feelings, actions, thoughts, and facts are connected. The adage “a
picture is worth a thousand words” captures the fact that many people prefer a visual
map to sets of verbal directions, and a body of research conducted by the team at the
Institute of Behavioral Research in Texas confirms that maps of thoughts and actions
communicate better than words (Dansereau & Cross 1990, Dansereau 1986, Evans &
Dansereau 1991, Lambiotte, Dansereau, Cross & Reynolds 1989).
Node-link mapping was first studied as a handy tool for helping students take better
notes during lengthy college lectures. In these studies, some students were taught to
take notes by placing key ideas in boxes called ‘nodes’ that were connected to other
nodes with lines (‘links’) representing different types of relationships. The final product
often resembled a map or flow chart of the lecture. Other students took notes as they
would usually take them. The results showed that students who used this ‘node-link
mapping’ system did better on tests and felt more confident about understanding the
lecture than did students who took traditional notes (see figure 1.). There seems to be
something about visually displaying information that helps us better understand things
and recall key ideas (hopefully when we need them).
Figure 1: Simple map of early mapping research
The ‘node-link map’ is a simple idea. The circles or boxes are the nodes, and usually
contain concepts, objects, actions, and feelings rather than towns or cities. The links
between the circles or boxes represent relationships between their contents.
5
Types of maps
Node-link maps are tools that can visually portray ideas, feelings, facts, and experiences.
There are three broad categories of these maps:
•
Free or process maps
•
Information maps
•
Guide maps.
Although this manual uses the category of maps called ‘guide maps’, it is helpful for the
potential user of mapping approaches to have a broad overview of all the ways
mapping can be used successfully.
Free or process maps: using an erasable board, flip chart, or paper and pencil, client(s)
and keyworker can work together to create a map of the problem or issue under
discussion. The keyworker should take the lead in briefly explaining mapping to the
client(s) and providing a starting point for creating the map. However, when at all
possible, both keyworker and client should have pencils or pens available to facilitate
the joint creation of a map. Figure 2 shows an example of a free map or process map
created during a group session on ‘relapse’. In this case, the counsellor created the map
on an eraser board with group members’ input and led a process discussion on the
issues raised:
Free mapping
Figure 2: an example of free mapping
Information maps: information maps have been used in a variety of settings to help
communicate basic information in a readily understandable way. Information maps are
usually prepared ahead of time to serve as handouts or presentation slides. These maps
organise facts in a specific content area and present them in an easy-to-remember
format. Early mapping studies with clients attending psychoeducational groups on HIVrisk reduction found that information maps were useful in helping clients learn and
retain information about HIV transmission and high-risk practices (see figure 3).
6
HIV is a human virus that invades and destroys the cells of the immune system.
AIDS is the late stage of HIV infection, resulting in illnesses and cancers the body can no
longer fight off
Figure 3: an example of an information map
Guide maps: the mapping exercises contained in this manual use guide maps. Guide
maps are pre-structured templates with a ‘fill-in-the-space’ format that help guide the
counsellor-client interaction during a session, while also allowing ample freedom for
self-expression. As part of an individual counselling session, these maps provide a
structure for thinking about and talking about goals, personal resources, and specific
steps and tasks for arriving at goals. In group work, guide maps can be used as
homework or as individual worksheets that are then processed and discussed within the
larger group. These mapping activities can provide some assurance that each group
member has had a chance to visit a particular issue personally. Similarly, guide maps can
be used to focus and keep a discussion on track. An example is given in figure 4.
Mapping guide 1: Exploring Self (Map 1)
How useful was this map and discussion?Not useful 1---2---3---4---5---6---7---8---9---10 Very useful
Comments:
Figure 4: an example of a guide map
7
Mapping as a keyworking or counselling tool
Mapping has evolved as a counselling tool over the course of more than 15 years of
application and research. A key element – that mapping appears to help foster
understanding and support better recall – is potentially beneficial to the keyworking
relationship.
Mapping serves two major functions in the keyworking process. First, it provides a
communication tool for clarifying information and sharing meaning between keyworker
and client. It can be used effectively with whatever therapeutic orientation or style a
keyworker or counsellor follows. Second, regular use of mapping-based strategies helps
with the continuity of care. Mapping worksheets or notes can be placed in the client’s
file, so that discussions of care planning or treatment issues (around goals, for example)
can be picked up where they were left off at the end of the previous session. Clients
may also be offered copies of maps they have worked on in session to help with focus
and task completion between visits.
Using mapping as a tool assists the keyworker in structuring sessions to better address
key issues that are important to the client. Of course, from the client’s perspective, it is
the conversation itself that is most important. However, mapping can help make
treatment conversations more memorable, help clients focus, and give clients
confidence in their ability to think through problems and develop solutions.
Another benefit of creating maps with clients is having those maps available for
supervision meetings. When mapping is part of the keyworking or counselling process
with clients, this material can be discussed jointly in supervision. Maps placed in the
client’s file document and efficiently outline the work being done in session. This
provides a foundation and focus for supervisors to offer specific feedback and guidance.
Mapping and collaboration
Collaborative counselling approaches are emerging as effective strategies for improving
motivation and goal-setting and for helping clients feel that they were heard and
respected during sessions. These are seen as building blocks for a strong therapeutic
alliance and for instilling hopefulness and determination as clients begin their treatment
journey. A central skill in collaborative approaches is the eliciting and highlighting of the
client’s perspective. This includes encouraging clients to discuss in detail what needs to
change in their lives as they move through treatment, how they view the change
process, and what steps make sense for what they want to accomplish.
When mapping is used to engage the client, this type of collaboration is naturally
facilitated. Maps are co-created, and the content of a map – the thoughts, ideas, and
issues – are those raised and identified by the client. The map provides a focal point for
this work as the keyworker or counsellor skillfully elicits from the client what should be
written down, what should be noted in passing, and what should be addressed next.
As part of a collaborative model of care planning, keyworkers help clients develop a
clear picture of things they want to change as they enter drug treatment. This logically
involves a discussion of goals and the positive consequences of those goals. It also
involves assisting the client in identifying his or her available resources for tackling those
goals. Resources are identified broadly to include a client’s strengths, relationships,
attitudes, thoughts, skills, behaviours, and perceptions.
Within this framework, the keyworker accepts that a client’s goals may change during
the process of treatment and that the client is the primary determiner of when a
8
particular goal should be amended. Likewise, the keyworker accepts that a client’s most
salient and meaningful goals will often not reference alcohol or drug use. For example,
saving a marriage or relationship, getting and keeping a job, regaining a driver’s licence,
or committing to an educational course are more commonly identified goals. Ending or
controlling substance use becomes one of the factors or ways to achieve these major
goals.
The importance of feedback
An important part of this intervention is the use of feedback on a client’s situation as
part of the collaborative process. Good quality assessment of a client’s problems is a
crucial part in developing an individually-tailored treatment package. However, there is a
danger that focusing on data-driven assessment questionnaires may be off-putting for
clients, and disrupt the delicate initial relationship between client and treatment service.
Research across many therapeutic settings suggests that the formation of a strong
therapeutic alliance between client and therapist predicts good initial engagement and
retention in treatment. Therefore it is crucial that the results of any screening and
assessment done at treatment entry are shared with the client as a springboard for goalsetting and care planning. In many treatment settings, clients spend a lot of time and
effort completing forms they never see or hear about again. Given this, most clients will
be interested, if not a little eager, to have the chance to talk about an assessment they
have taken.
The Treatment Effectiveness Initiative in Birmingham and other parts of the West
Midlands has used the Client Evaluation of Self at Intake (CESI) as a tool to help plan
care. In addition, the data collected as part of the Treatment Outcome Profile (TOP) is
also a useful tool.
Using this manual
This manual is designed to help establish a good therapeutic alliance, enhance the
assessment of a client’s problems, identify client goals for successful treatment, and
foster motivation for ongoing work on those goals. The approach described may be
used with clients that are new to treatment, or with existing clients. The process is
summarized in figure 5.
•
Clients new to treatment: follow the process from the top left hand corner of
figure 5. Ideally, the three-session intervention should be started with clients
after issues of prescribing have been addressed (i.e. the opioid dependent client
has started on a prescription of methadone or buprenorphine).
•
Clients established in treatment: start the process either from session 2.
Each individual session can be completed during an average 50-60 minute appointment.
Sessions are built around a set of guide maps and have scripted talking points to help
the less experienced keyworker complete and discuss the maps with clients. After a few
initial experiences with using these maps, clinicians will quickly find a way to make it
their own.
9
COMPREHENSIVE
ASSESSMENT
Use other
maps as
appropriate to
enhance
collaborative
treatment
process
Re-set new goal(s)
using new Goal
Getter map
Including CESI + TOP
Initial Care Plan map
Goal not
achieved
Goal achieved
ASESSMENT BY
DOCTOR +
PRESCRIBING IF
RELEVANT
Complete
Success Map
Complete
Running into a
Brick Wall map
KEY WORKING
SESSION 1
KEYWORKING
SESSION 2
KEYWORKING
Using Node-Link
Maps to Enhance
Assessment
Developing an
Effective Care
Plan
Monitor and
Review Progress
See page
See page
SESSION 3
e.g. see
Appendix
ON-GOING KEY WORKING
Review latest Goal Getter map at
start of each session and set new
goals as appropriate.
Update Care Plan as appropriate
See Page
3-MONTH REVIEW
Figure 5: Summary of Care Planning Manual
Repeat Goal Planner map to
review current problems.
Complete Care Plan Update map
to review overall progress
Complete and feedback results
from TOP and CEST
Preparation stage
•
Familiarise yourself with mapping and with the guide maps used in each session.
A completed ‘case study’ example of each map is included for reference in
Appendix 3
•
Practice using these guide maps ahead of time. This can be done by completing
some of them for yourself, or by inviting a colleague to role play with you
•
Make copies of all the maps, organised by session. One easy way to do this is to
make a folder for each session to store copies of that session’s guide maps.
Some clients may want more than one worksheet, so be prepared with extras
•
With a client new to treatment, spend some time reviewing the initial
assessment documentation completed by the client. Allow enough time to
complete an Assessment Feedback Map (page 20) based on the information.
Working with clients
•
When first introducing the client to using guide maps, provide a brief
explanation of how the maps are used. For example, “maps are tools to help us
structure our discussions and better focus on the things that are important to
you,” or “mapping is a way of looking at things that you may want to work on
as a part of treatment” You may want to further add: “Some people have found
these maps to be helpful for ‘seeing’ things more clearly and remembering
important ideas.”
•
Assure the client that maps don’t have to be filled up with words. Concise
summaries, shorthand, abbreviations, single words, and even pictures can be
10
used to represent the ideas the client wants to focus on. Some areas of a map
may contain more words/information than others; some boxes may be left blank
•
Sit in such a way that you can work on a map as a collaborative project with the
client. This might mean sitting around a table or inviting the client to move to
the corner of the desk so that both counsellor and client have a clear view of the
worksheet. Offer clients a variety of pencils or markers with which to work
•
Frequently validate and affirm clients’ responses during mapping sessions. There
are no ‘right’ or ‘wrong’ responses for completing a map. In the spirit of
collaboration, counsellors’ responses should most frequently reflect interest and
curiosity about the clients’ perspectives.
11
Session 1
Getting started: using maps to enhance assessment
Getting started: first maps sets the collaborative tone for subsequent sessions and
introduces the client to working with guide maps. The keyworker takes the lead in
introducing the guide map template. This begins with an opportunity for the client to
describe their current situation, and to review a recently completed comprehensive
assessment document, or the achievements of treatment so far. The focus then moves
onto a discussion about areas of concern and changes that the client would like to
make in their life through treatment. The session ends with an invitation for the client to
consider the positive factors that can support their efforts in treatment.
Further reading: see appendix 1 (p48)
Notes for session 1: a set of guide notes is included for each map. Blank copies of each
map for you to copy and use with clients follow the guide notes. Sample maps filled out
based on the case study are given in appendix 3. Read over the sample case study maps
to get a feel for completing the maps with clients.
The maps
There are three maps that provide the focus for your first session with the client, and a
fourth map for client homework:
•
Map 1: a map for exploring the client’s views about their current situation (‘Me
Today’)
•
Map 2: a map summarising key elements from the initial comprehensive
assessment process (‘Assessment Feedback’)
•
Map 3: a map for discussing the client’s pressing concerns (‘Things I Would Like
to Change’)
•
Map 4: (homework) a map for identifying strengths/resources (‘Strengths’).
Introduce the client to the idea of working on the map worksheets together in the spirit
of collaboration and better understanding. Most people begin the treatment process
hopeful that their lives can be better. Let the client know that if he/she is able to make
a change or address even one small thing as part of treatment, then that is some
measure of success.
Convey that you are interested in carefully understanding the client’s perspective and
that the maps are helpful for focus and concentration. Mapping helps you capture ideas
without a lot of words. Listen carefully to what the clients says, then add that
information as a concise summary. For example: “I was having a bad time back then – I
lost my job, then my house” might be summarised on a map as ‘lost job, then house’.
12
Map 1: ‘Me Today’
1. Use some of these ideas to introduce the first map to the client (map 1.1 p19):
I’d like to start today by talking about you. If you’re okay with it, I’d like to use this
map to get a summary of how you see your life today. You gave us a lot of
information when you completed the initial assessment process, and I am going to
come back to that in a minute. However, much of this involved you answering
questions that we set. Now I want to hear your views on your situation in your
own words.
I am going to use this map to take notes as we talk. To get us started, I’ll write
down some of the things you tell me, but I want you looking over my shoulder to
make sure I get it right. Drugs or alcohol are clearly a problem for you, or else you
wouldn’t be here today. However, I want to hear about other areas of your life
too, both good and bad. We can write whichever categories are most important
to you in the boxes, but others have used some of these titles at the bottom.
Imagine this piece of paper is going to form a summary of your life as it is now, so
that someone that didn’t know you could understand your situation just using this
one piece of paper. Do you think you can do that? Take a minute to think.
2. Work collaboratively with the client to build this map. Engage the client with
invitations to fill in parts of the map. Try to encourage the client to discuss their whole
situation, and not just drug-related issues. Convey the idea that you are interested in
helping them tackle more than just drug issues, and that other problems might be
related. Encourage the recording of positive information (e.g. about children, family,
employment, skills) as well as problems. For example:
How do you spend your free time at the moment? How did you spend it before
you started using drugs? What would you do if you had unlimited money/time?
What is your mood like most of the time? How would your friends describe you?
3. When the client says that the map is finished, conclude the map by summarising
what the client has brought forward. For example:
Your map gives me a good idea about how things are for you at the moment. I
can see that drugs have caused you a lot of problems, and there are other
difficulties in your life. However, I can also see that you have a lot of other talents
and abilities.
4. Transition to the next map:
I have another map I’d like to show you. I filled this one in based on some of the
questionnaires and evaluations you have completed as part of the initial
assessment process.
Map 2: ‘Assessment Feedback’
1. If the client is new to treatment, continue the theme of talking about the client’s
current situation by presenting a summary of the findings from the various assessments
done at initial intake (e.g. comprehensive assessment document, scales such as the
Treatment Outcome Profile (TOP) or the Client Evaluation of Self at Intake (CESI), drug
screening results, blood tests etc). This information should be summarised on the
assessment feedback map (map 1.2, p 20) that you will prepare in advance of the
session. This map provides a way of gathering key elements of this information on one
13
sheet of paper. Going over it with the client, in conjunction with the ‘Me Today’ map,
enables the keyworker to demonstrate that they have understood all of the client’s
concerns, and prepares the foundations of a client-focused care plan.
A similar process can be done with clients that are established in treatment, except the
focus will be in progress and achievements so far. Alternatively, data from the most
recent three-month review (e.g. TOP data) can be used.
2. Introduce the Assessment Feedback Map and review each of the nodes with the
client.
It’s good to hear your thoughts about how you see you life at the moment. I’ve
drawn up a map that summarises some of the results from questionnaires and
evaluations that you completed as part of your assessment, and I hope that this
will help us to decide which are the most important problems to tackle in
treatment.
3. Use open-ended questions to encourage the client to reflect on each of the issues
addressed in the nodes. Focus discussion on how these issues relate to possible needs,
problems, and challenges in treatment.
4. Transition to the next map:
Based on the things we’ve been talking about, let’s complete another map that
can help identify some possible goals for the future.
Map 3: ‘Things I Would Like to Change’
1. Transition into the next map by turning the client’s attention toward his/her possible
expectations about treatment (or the next stage of treatment). The tone of the map
might reflect the general idea of, ‘What needs to change in order for you achieve your
preferred future?’
2. Use map 1.3 (‘Things I would like to change’, p 21) to invite the client to consider
how he/she might like his/her life to be different or better as a result of entering
treatment.
What are the things that you might want to work on in treatment that could
make the most difference in your life, either now or in the future? How would
you describe the problem or difficulty you would like to change?
3. After the client describes and discusses each change that might be helpful, ask the
client to give some details about how accomplishing that change would make things
better. For example:
Client: The main thing for me will be to work out how I can get back to work.
Keyworker: It sounds like you have already been thinking about this. How will
getting back into employment make things better for you?
4. Work collaboratively with the client to complete the map, filling in the nodes with the
client’s words and checking frequently with the client to make sure you are noting
things the way he/she prefers.
5. End the discussion with a summary of the key issues and concerns raised by the client
and ideas about how changes will make things better. Transition to homework map:
14
The next map is one for you to complete on your own between now and our next
meeting together.
Map 4: ‘Strengths’ (homework)
Invite the client to continue thinking about issues that should be addressed as part of
treatment and how these might be tackled. In particular, the homework map asks the
client to think about personal strengths and resources that are available to help with the
work ahead.
Give the client a copy of the Strengths map (Map 1.4, p 22), briefly review it, and assign
it as ‘homework’:
I’m impressed with the careful thought you have given to the issues you would
like to tackle during treatment.
Between now and our next appointment, I’d like you to think about yourself and
consider the personal strengths and resources you bring to solving these
problems. This map has several boxes or ‘nodes’ where you can jot down your
thoughts about your strengths.
Try to hold back the tendency to be self-critical. Try to think about and jot down
at least one strength you know you have for each of the boxes. Pay attention to
yourself and add strengths to your map as you observe them in yourself during
the coming week.
Bring this map with you for our next session so you can tell me about those things
about you that will help you make the changes you want to make.
Ending the session
Thank the client for participating and for giving the activities some thought. Make sure
the client is given a copy of all the maps produced in the session, and put another copy
in the clinical casenotes. Briefly ask the client to rate the usefulness of the maps worked
on in the session on a scale of 1 to 10. For example:
I’m interested in how useful you found these maps that we worked on today.
Overall, if 1 equals ‘not useful’ and 10 equals ‘very useful’, how would you rate
the maps and our discussions?
If client’s overall rating is lower, ask: I wonder how we can make these maps more
helpful for you.
Think about it and let me know at our next session.
Other potential maps
As the keyworker becomes more familiar with the idea of using visual node-link maps to
facilitate and enhance treatment sessions, it is anticipated that they may stray off the
‘script’ outlined in this manual. Free maps are the ultimate tool for experienced worker,
but other guide maps may also be useful for linking assessment with care planning.
These are presented in appendix 2 (p 54):
‘Why Should I Give up Drugs?’/ ‘My Health’/ ‘My Emotions’/ ‘Life Story’/ ‘My Social
Network’/ ‘Peer Inventory’
15
Client:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Map 1.1 ‘Me Today’
16
Date: __/__/__
Family Health Emotional Interests Education Fun Work Friends
Areas to consider:
Me
Today
Keyworker:
Maps for Session 1
Client Name:
Treatment efforts to date
Keyworker:
Date: /
Map 1.2
Assessment
Feedback
/
Education, work, offending
history
Severity of substance
abuse
Current
Problems and
Resources
Emotions/Temperament
Social support, family
Housing and basic needs
Major Strengths
Possible challenges
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
17
Map 1.3 Things I would like to change Describe what you want to
change
(Use back if needed)
How useful was this map and discussion?
Not Useful 1 –2–3
–4–5–6 –7 –8–9 –10 Very Useful
Comments: How would life be different if
it happened
Client Name:
Keyworker :
Date: /
/
18
Client Name:
M ap 1 .4
S t r engt hs
Health and Physical
Keyworker:
Date: /
/
Problem Solving/Coping
Social Relationships
Emotions/Temperament
What are your
strengths?
Values and Beliefs
Work or Skills
Client Name:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Keyworker:
Date: /
/
19
Session 2
Developing an effective care plan
Developing an effective care plan helps clients begin to identify and prioritise salient
goals to work on as part of treatment and to narrow those goals down to clear, specific,
and practical plans. Clients first review their homework guide map to discuss strengths
and resources they bring to the task. The ‘Goal Planner’ map is used to begin
exploration of goals and these are drawn up as a care plan. The ‘Goal Getter’ map is
then used to invite a conversation about specific steps to take first. As homework, the
client is invited to tackle the first tasks on the ‘Goal Getter’ map, ready for review at the
next treatment session. Copies of the care plan and ‘Goal Getter’ maps are given to the
client and provide a reminder of tasks for the coming weeks.
Further reading: useful materials on goal setting and treatment planning can be found
in ‘Chapter 5: CRA Treatment Plan’ in Clinical Guide to Alcohol Treatment: The
Community Reinforcement Approach by Robert J. Meyers & Jane Ellen Smith, The
Guilford Press, New York, 1995.
Notes for session 2: a set of guide notes is included for each map. Blank copies of each
map for you to copy and use with clients follow the guide notes. Sample maps filled out
based on the case study are given in appendix 3. Read over the sample case study maps
to get a feel for completing the maps with clients.
The maps
There are three maps that provide the focus for this session with the client, including a
map for client homework:
•
Homework map: review ‘Strengths’ map from previous session
•
Map 1: a map that ensures all possible problem areas are considered (the ‘Goal
Planner’)
•
Map 2: a (summary) care plan map capturing the top priority problem areas
•
Map 3: a ‘Goal Getter’ map to explore each chosen problem in detail and to set
SMART goals.
20
Homework review: ‘Strengths’
1. Allow time at the beginning of session for discussion about the self-study map on
strengths and resources. For each of the life areas identified in the nodes, use some of
the following process questions to engage the client in conversation:
How did you go about identifying your strengths in this area?
What kinds of good qualities have people told you have when it comes to ______
(e.g., your temperament, your work, your values, etc)?
How do you think you gained this strength?
What things are you aware of that you do to work on this strength?
What would someone who is really close to you (parent, spouse, etc) say is your
biggest strength or personal resource?
If a client reports not having had the time to complete the map, etc., simply use a blank
copy of the map to help the client catch up by identifying his/her personal strengths in
each of the areas.
2. Summarise the discussion by asking the client to focus how his/her personal strengths
will help with the changes the client wishes to make in the future:
In our last meeting, you discussed several things you want to change for the
better. How will your strengths help you with the changes you want to make?
Which of your personal strengths will serve you the most? How do you intend to
keep working on this strength? What do you need to remember to keep doing?
3. Transition to the goal planning map:
The maps we will work on today are for looking at some of the important things
you want to accomplish once you leave here. Be sure to keep your knowledge
about your personal resources in mind as you think about how you will go about
making things better for yourself in the future.
Map 1: ‘Goal Planner’
1. Transition to the ‘Goal Planner’ map (map 2.1, p 32) by reviewing general problem
solving models with client:
Our task for the rest of this session is to draw up a plan for tackling your
problems. However, before we can do that, we need to be absolutely sure which
problems we are tackling. Sometimes when people first come for treatment, it
seems that nothing else in their life matters other than the drugs. However, as we
have discussed already, there are lots of other issues that we could look at that
are just as important.
Sometimes these problems follow on from using drugs, but sometimes they are
part of the reason that you started using the drugs in the first place [Give an
example e.g. using drugs to help calm down, to aid sleep, or because all of your
friends use]. It is often helpful to check that we know clearly which are the
important problems for you, so that we can tackle them one-by-one, and in the
right order.
As we think about it, it may seem like we have more things we want to try to
21
change immediately than we realistically have time and energy to do. It’s also
true that sometimes when we take action in one area, other areas get better
without as much effort. So planning how we want to tackle our goals for
treatment makes sense.
Using this map, let’s make some notes about the issues that you think about as
being the most important or urgent for you to work on during treatment. This can
include things you would like to address right now, but it can also include
problems or goals you know you’ll need to tackle in the long run in order to live a
drug-free life.
For example, some clients use treatment sessions to improve their skills e.g. in
solving problems in their life, being able to say ‘no’ to others, or to increase their
range of interests or activities. Others focus on topics such as parenting, building
better relationships, maintaining motivation to stay off drugs, learning better ways
to deal with anger – those sorts of concerns.
2. Show the client the ‘Goal Planner’ map, and also have the Goal Planner Rating Sheet
(p33) ready to show the client.
This map contains nine areas where you (or indeed any of us) might be
experiencing problems.
I would like you to go through each area in turn, and score your current
satisfaction with this part of your life between 1 and 10. Use this extra sheet (Goal
Planner Rating Sheet) to help you.
For example, if you score ‘Physical Health’ as a ‘1’ this means you cannot imagine
your physical health could be any worse than it is at the moment. Alternatively, a
score of ‘10’ would mean that you couldn’t imagine feeling any better.
3. When the client has completed all nine scores, go through each of the areas and
discuss what the score means to the client. For example
You have rated ‘Money’ as a ‘3’. What would have to happen to make it a ‘7’? or
a ‘10’?
Try to get a deeper understanding of what the client means by the score, and how it
could be improved. Write down exactly what they say for each area in the larger boxes
in the middle of the map – this information provides the basis for a potential goal that
could be set for the client to achieve. For example
‘You scored ‘Money’ as a ‘3’, but in order for it to be a ‘7’ you would have to get
rid of all the debts that you have to dealers and other friends. In order for it to be
a ‘10’, you would need to get a well paid job, or win the lottery!
4. The task is now to prioritise the problem areas in order to find the best one (or a ‘top
three’) to work on first. These may be the three areas with the lowest scores, but not
always. Remember that by agreeing to tackle a ‘middle-ranking’ problem, you may have
more chance of early success, thus building the client’s confidence. Spend some time
ranking the problems in terms of importance to the client, coming up with at least the
first three. Useful material on goal setting can be found in ‘Chapter 5: CRA Treatment
Plan’ in Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach
by Robert J. Meyers & Jane Ellen Smith, The Guilford Press, New York, 1995.
22
Map 2: ‘Care Plan’
1. Having spent some time exploring the full potential range of problem areas, the task
now is to draw up a Care Plan (p34) to structure the initial attempts to tackle these
difficulties.
2. Choose the top three problem areas identified from the Goal Planner map, and enter
them in the column on the left of the Care Plan.
3. Transfer the information relating to these areas from the larger text boxes on the
‘Goal Planner’ map, and enhance this with any other relevant detail.
4. Start to plan goals to tackle each of the three problem areas identified.
Some people find it helpful to have a system for thinking-through how we are
going to accomplish the things we know we want to do. When our goals and
concerns are important but we don’t sort them out, we can feel stress and selfdoubt.
It’s likely you’ve already spent a lot of time thinking about how you want your life
to be.
Let’s use the three problems that you have identified as most important and try to
break them down into small and achievable steps.
5. Transition to the ‘Goal Getter’ map. This takes one of the goals identified on the Care
Plan, and breaks it down into smaller steps, as well as reminding the client of other
support that they may have to achieve these goals.
Map 3: ‘Goal Getter’
It is useful to break down individual goals into smaller steps that are ‘SMART’
Specific: make the step as specific as possible and express it in positive terms.
Do you want to stop using cannabis or cut down your use? How much money do
you want to save each week?
Measureable: you will need a way to evaluate progress and work out if the client is
achieving each step towards their goal.
How ill you know if you have cut down your use? Will you measure this is money?
Number of days used? Number of times used? How will you know when you are
feeling less depressed?
Achievable: is the step achievable? Does the client have the resources necessary to
achieve each step? Can any obstacles be identified and removed before starting?
Realistic: setting unrealistic steps or goals is counterproductive, as it is likely to end in
failure. If a client fails to achieve a step, this leads to demoralisation, and potentially to a
drop in motivation. Therefore make all the steps set in the early stage of the Care
Planning process overly simple, to ensure that the client has every chance of succeeding.
Then praise them extensively for achieving the step/goal.
Time-limited: all steps must have a review date attached to them. At first, this should
be as close as possible to the date that the goal was set on, allowing quick feedback
and progress.
23
1. Invite the client to continue working on making thoughtful plans to address his/her
concerns and goals to be achieved during treatment. Give the client a copy of the ‘Goal
Getter’ map (p35), and explain how to use it:
Your number one priority identified on the Care Plan was to increase your level of
exercise. Can you think of any way of doing this?
Engage the client in completing the map. Lead the discussion so that it follows the
map’s template. Start by breaking down the goal into a number of smaller steps,
following the principles described above. Encourage some thought and discussion about
identifying a more concrete goal and several steps that might be involved in the goal:
You’ve said that changing your relationship with your wife is one thing that seems
important for you to address. Part of this is working out how to walk away or
handle disagreements differently. How might you go about learning that? What’s
one thing you could do to work on this?
Once the steps to achieve a certain goal are established, enquire about possible
problems that the client might encounter. At this point it is common to realize that the
steps set to achieve the goal are still too large and difficult to achieve, and they may
need further revision.
Add information about the client’s strengths and social supports that might help them
achieve their goal.
At the end of the session the client will be expected to attempt to achieve the steps set
one or more ‘Goal Getter’ maps. Make sure that a review date has been set, and that
this is followed-up (it might be done over the phone or face-to-face).
Ending the session
Thank the client for participating and for giving the activities some thought. Make sure
the client is given a copy of all the maps produced in the session, and put another copy
in the clinical case notes. Briefly ask the client to rate the usefulness of the maps worked
on in the session on a scale of 1 to 10. For example:
I’m interested in how useful you found these maps that we worked on today.
Overall, if 1 equals ‘not useful’ and 10 equals ‘very useful’, how would you rate
the maps and our discussions?
If client’s overall rating is lower, ask:
I wonder how we can make these maps more helpful for you. Think about it and
let me know at our next session.
24
Legal &
crime
Exercise
Money
Job/
Education
Housing
(Partner or family)
Relationships
Social life &
friends
(physical &
mental)
Health
Drug and/or
alcohol use
Problem
Area
Client:
Satisfaction
out of 10
Goal Planner
Priority
Date: __/__/__
What would have to change to increase my score out
of 10?
Keyworker:
Maps for Session 2
[Adapted from the Happiness Scale. Copyright 1995. Used with permission from the authors, Robert
Meyers, Ph.D., and Jane Ellen Smith, Ph.D.]
25
[Adapted from the Happiness Scale. Copyright 1995. Used with permission from the authors, Robert
Meyers, Ph.D., and Jane Ellen Smith, Ph.D.]
26
1 = it can’t get any worse
5 = not unhappy, but not happy either
10 = it can’t get any better
Give each area of the Goal Planner map a score between 1 and 10 to show
how happy you are now with this area of your life
Goal Planner Rating Sheet
It can’t get any worse…………………...............….…It can’t get any better
1 2 3 4 5 6 7 8 9 10
27
Date: __/__/__
Keyworker Signature:
________________
________________
__/__/__
Review Date::
Goals for tackling this problem
Keyworker Name:
Client Signature:
Summarise the Problem
Client Name:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Problem Area
Sheet Number:
Care Plan
28
‘Goal Getter’
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Keyworker:
MY GOAL
Specific Actions
Client:
Possible Problems
Helpful people
& useful thoughts
Map 2.4
__/__/__
Solutions
Strengths you
have or need
When
Date:
Session 3 and beyond
Mapping progress and future plans
Mapping progress and future plans provides an outline for reviewing use of the ‘Goal
Getter’ map and transitioning to a discussion about progress made towards achieving
the goals set. The format outlined in these goal-focused mapping sessions can be used
for future sessions with the client. A selection of additional maps for subsequent
sessions is included that provide templates for reviewing progress toward goals,
discussing successes, exploring set-backs, and engaging in further decision making.
Helpful maps from previous sessions also can be used again with clients who may
identify new goals and concerns.
Further reading: see appendix 1, p48
Notes for subsequent sessions: a set of guide notes is included for each map. Blank
copies of each map for you to copy and use with clients follow the guide notes. Sample
maps filled out based on the case study are given in appendix 3. Read over the sample
case study maps to get a feel for completing the maps with clients.
The maps
In addition to reviewing the ‘Goal Getter’ map set as homework, there are 4 new maps
for working with clients in subsequent sessions. These maps are designed to help keep
sessions focused on goals, plans, and tasks related to the clients treatment needs.
•
Homework map: review ‘Goal Getter’ map
•
Map 1: a map for exploring successes (‘What Was Your Success?’)
•
Map 2: a map for exploring set-backs (‘Running into a Brick Wall’)
•
Map 3: a map for making difficult decisions (‘Decision’)
•
Map 4: a map for updating goals (‘Care Plan Update’).
29
Homework review: ‘Goal Getter’
1. Start the session by discussing the progress in achieving the steps outlined in the
‘Goal Getter’ map created at the end of the previous session. Review and discuss each
of the steps identified on the map in relation to the stated goal and tasks.
2. If the client has been successful in achieving any of the steps on the ‘Goal Getter’ (or
Care Plan) map, praise their achievements. Use the ‘Success’ map (map 3.1, p 44) to
reinforce this achievement, and to gather information about techniques that may be
useful again in the future.
3. Alternatively, if the client hasn’t been successful in achieving one or more steps,
praise any success that they may have had, but move on to the ‘Running into a Brick
Wall’ map (map 3.2, p45) to help structure a discussion about what went wrong. It is
likely that the step was too large or complicated to complete in the time set, and time
may be usefully spent in trying to break it down into smaller components.
4. Exploration of steps or goals often leads to a difficulty in making an important
decision. The ‘Decision’ map (map 3.3, p46) can help a client to develop good decisionmaking skills.
Map 1: ‘What Was Your Success?’
1. Suggest the ‘Success’ map based on client’s report of something having gone well,
either recently or in the past.
It sounds like you’ve been busy since the last session and that you had a success. It
can be a good idea to take a close look at how we get things to happen. Take a
look at this map…
2. Complete the ‘Success’ map with the client. Listen reflectively as the client works
through the nodes of the map and discusses how the success happened and what has
been learned.
3. Once the map has been completed and discussed, ask processing questions to help
the client further consider aspects of his/her successful action.
At the time, did you think about _________ as a “success”?
You seem to have carefully thought about what might work in this situation. In
what other situations have you used this kind of thinking?
You noted that through this success you learned _________________ about
yourself. What else did you learn about yourself?
Who else will be (was) affected by your success? What would (did) they say?
When you have done _____________________ (whatever needs to happen next),
what will you notice that is better in your life?
4. Summarise the discussion. Transition to setting further goals/steps using the ‘Goal
Getter’ map (or one of the subsequent maps) or assign it as homework, based on what
the client identifies as the next useful area of exploration.
30
Map 2: ‘Brick Wall’
1. Suggest the ‘Brick Wall’ map based on client’s report of having a set-back or other
experience that did not turn out as desired, either recently or in the past.
So testing yourself by going to the bar with friends didn’t work out so well. In this
map, it’s shown as sort of running into a brick wall…
2. Complete the ‘Brick Wall’ map with the client. Listen reflectively as the client works
through the nodes of the map and discusses how the set back happened and what was
learned.
3. Once the map has been completed and discussed, ask processing questions to help
the client further consider different aspects of the set back:
At the time you ______________, did you wonder if you might be heading for a
brick wall? What did you tell yourself?
What other thoughts or action did you have leading up to _____________.
Who else will be (was) affected by your set back? What advice might they give
you (did they give you) about what happened?
How did you figure out what to do to keep things from being worse?You noted
that what happened made you wiser by ________________. How will you use this
new wisdom in the future?
4. Summarise the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
Map 3: ‘Decision Map’
1. Suggest the ‘Decision’ map based on client’s report of having difficulty or
ambivalence about making a decision toward pursuing a goal or task.
Based on what you’ve told me, you seem to be stuck. On the one hand, _____
seems a good idea, but you are also thinking about ______________. This map
can help with looking closely at both sides…
2. Complete the ‘Decision’ map with the client. Listen reflectively as the client works
through the nodes of the map and discusses the pros and cons of each choice in the
decisional balance.
3. Once the map has been completed and discussed, ask processing questions to help
the client further discuss thoughts and feelings about the decision:
What got you to thinking that you needed to make a firm decision about
______________?
There are three boxes for possible choices and consequences. If you had to add
one more box to each list, what would you put in those boxes?
Who else will be (was) affected by your set back? What advice might they give
you (did they give you) about what happened? What else have you considered
might be positive about ______________ (one of the choices)? And what else
might be negative about that choice?
31
What will tell you or give you confidence that the choice you picked is the best
one for right now? How will you evaluate it?
4. Summarise the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
Map 4: ‘Care Plan Update’
1. Suggest the ‘Care Plan Update’ map when a check up session to assess progress and
future tasks seems relevant. This map is also suitable for working on a client’s report of
having made some progress toward completing tasks.
Let’s review where you are today, based on the goals and areas of concern you
said you wanted to address as part of your re-entry plan.
2. Complete the ‘Care Plan Update’ map with the client. Listen reflectively as the client
works through the nodes of the map and discusses progress, tasks completed, and ideas
for things to tackle next.
3. Once the map has been completed and discussed, ask processing questions to help
the client further talk about commitment to working on goals:
It looks like you have been making some good progress on _________. What
helped you get this step done?
You’ve noted that you’ve not started any work toward _____________. Is this still
a valid goal for you, or do you want to reconsider or change it?
Who else has noticed that you have made progress in working on ______? How
did you tell them you were able to make progress?
In addition to __________________, what else is left to do so that you will have
addressed your goal of _________________ in the way you want to?
What gives you the motivation and confidence to keep working on these goals?
4. Summarise the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
Ongoing keyworking
The set of maps for subsequent sessions provide a format for continuing discussions
about the client’s concerns, goals, and tasks for re-entry. These maps can be used
individually or several can be worked on in the same session.
Subsequent mapping sessions can follow the format that has been outlined in earlier
sessions in this manual. That is, begin the session with a map that has been assigned for
homework or self-study. After discussing the core issues identified by the client, use the
remainder of the session to work on one or two maps that seem relevant to issues the
client is working on.
This open presentation of further maps allows programmes to pace the number and
frequency of individual keyworking/counselling sessions, based on the pragmatics of
what is possible. Ideally, continuing with regular goal/step setting throughout treatment
is suggested. A review of a ‘Goal Getter’ map is a useful start to any keyworking
session. Alternatively the broader goals may be reviewed using the Care Plan or the
32
‘Care Plan Update’ maps. Administering the ‘Goal Planner’ map every three to six
months can also be a useful way of ensuring that important problem areas are not
missed.
Got more maps?
There are several larger collections of maps available for free downloading at
www.ibr.tcu.edu These address a variety of treatment issues, including maps that focus
on 12-steps, maps for examining relapse, and health-focused maps on issues such as
HIV prevention, exercise, and relaxation.
33
Maps for Session 3 and beyond
Map 3.1
Client Name: What was your success?
Keyworker:
Date: /
/
How did you
make it happen?
What did you do to
make it happen? How did you decide
what might work?
What did you learn
about yourself? How can you use what you learned from this experience in the future?
How useful was this map and discussion?
Not Useful 1 –2–3
–4 –5–6–7 –8–9 –10 Very Useful
Comments: 34
Client Name: Map 3.2 Running into a
Brick wall
Keyworker:
Date: /
/
What was the unsuccessful attempt?
What made it
unsuccessful?
Your actions? Your thoughts?
Describe how this has
happened to you before
What can you do differently next time?
How useful was this map and discussion?
Not Useful 1–2 –3
–4 –5–6 –7 –8 –9–1 0 Very Useful
Comments: 35
Map 3.3
Decision
Client Name: Keyworker:
Date: /
YOU HAVE A DECISION TO MAKE
ABOUT... /
Possible Choices
You Can Make A
C
B
Consequences
of each choice POSITIVE NEGATIVE
POSITIVE
NEGATIVE
POSITIVE
NEGATIVE
WHICH CHOICE SEEMS THE BEST?
How useful was this map and discussion?
Not Useful 1 –2–3
–4 –5–6–7 –8–9 –10 Very Useful
Comments: 36
Map 3.4
Care Plan
Update Client:
The problems I have Keyworker:
Progress I have made
in tackling them (Use back if needed)
Client Signature:
Date: __/__/__
What is left to do?
Keyworker Signature:
How useful was this map and discussion?
Not Useful 1– 2–3–
4 –5–6 –7 –8–9 –10 Very Useful
Comments: 37
Appendix 1:
The research evidence for node-link mapping
Node-link maps have an empirical base in research dealing with the effects of using two
dimensional visual representations. These graphic representations are frequently found
to be more effective than verbal discourse or written narrative in dealing with complex
problems and issues. Flow charts, organisational charts, Venn diagrams, pictures, and
graphs can increase communication efficiency by making related ideas easier to locate
and recognize, and, as a result, potentially more amenable to inferences and recall
(Greeno, 1980; Larkin & Simon, 1987; Mayer & Gallini, 1990). Spoken language or
written narrative are in physical formats that produce linear ‘strings’ of ideas. Visual
representations, on the other hand, have the capability of simultaneously clustering
interrelated components to show complex multiple relationships such as parallel lines of
thought and feedback loops.
Complexity often makes personal problems both difficult to analyze and solve, and
emotionally daunting. A visual representation such as a node-link map can capture the
most important aspects of a personal issue and make alternatives more obvious for both
the client and the keyworker/therapist. Because this has the potential to make a
problem appear more manageable and a solution more probable, it may diffuse at least
some of the anxiety surrounding the issue, as well as increase motivation to work
toward a solution.
In 1989, maps were first studied as personal management tools for college students in
substance abuse prevention research funded by the National Institute on Drug Abuse
(NIDA) in the USA. Later, maps were also introduced to heroin dependent clients and
their counsellors in three urban Texas methadone clinics as part of the DATAR project
(Drug Abuse Treatment for AIDS Risk Reduction). Positive findings from this research led
to the use of node-link maps in the CETOP project (Cognitive Enhancements for the
Treatment of Probationers). Again, this confirmed node-link maps as useful counselling
tools, this time with a particularly complex client group (probation violators in a criminal
justice system treatment program). Some of the maps in this manual were initially
created by Don Dansereau and colleagues for the DATAR and CETOP projects, and then
modified by counsellors in the studies to suit their clinical needs. Others were created in
drug services in Birmingham and the North-West region of England as part of the BTEI
and ITEP projects.
Research evidence now exists to support the use of node-link mapping in drug
treatment sessions. The following provides a summary of the potential benefits:
Quality of the therapy session
Memory for the session: maps make treatment discussions more memorable (K.
Knight, Boatler,& Simpson1991, K. Knight, Simpson, & Dansereau 1994)
Focus: maps increase on-task performance in group sessions and are especially helpful
for clients who have problems maintaining attention (Dansereau, Dees, Greener &
38
Simpson 1995, Dansereau, Joe & Simpson 1993, D. Knight, Dansereau, Joe & Simpson
1994, Joe, Dansereau & Simpson 1994, Czuchry, Dansereau, Dees & Simpson 1995,
Dansereau, Joe & Simpson 1995).
Communication: maps give clients greater confidence in their ability to communicate.
This is especially so where English is not the first language and clients with limited
education (Pitre,Dansereau & Joe 1996, Dansereau, Joe & Simpson 1996, Blankenship,
Dees & Dansereau1997, Newbern, Dansereau & Pitre 1999).
Ideas: maps facilitate the production of insights and ideas. They can help to:
•
stimulate greater session depth (Dansereau, Dees, Greener & Simpson 1995,
Newbern, Dansereau & Dees 1997)
•
identify gaps in thinking (Pitre, Dansereau & Simpson 1997)
•
uncover psychological issues (Collier, Czuchry, Dansereau & Pitre XXXX, Czuchry
& Dansereau XXXX, Dansereau, Joe & Simpson 1993)
•
provide greater breadth (Dansereau, Joe & Simpson 1993).
Quality of client & therapist relationship
Mapping facilitates the counsellor-client therapeutic alliance (Dansereau, Joe & Simpson
1993, Dansereau, Joe & Simpson 1996, Dansereau, Joe, Dees & Simpson 1996,
Simpson, Joe, Rowan-Szal & Greener 1996).
During treatment outcomes (e.g., issue resolution & more effective life skills):
•
Positive feelings toward self and treatment: maps facilitate self-confidence, selfefficacy & problem solving. They can foster positive feelings about personal
progress in treatment and positive perceptions of treatment process (Dansereau,
Joe & Simpson 1993, Dansereau, Joe & Simpson 1995,Dansereau, Joe, Dees &
Simpson 1996, Joe, Dansereau & Simpson 1994, Pitre, Dees,Dansereau &
Simpson 1997, Czuchry, Dansereau, Dees & Simpson 1995, D. Knight,
Dansereau, Joe & Simpson 1994, Pitre, Dansereau, Newbern & Simpson 1997,
Blankenship, Dees, & Dansereau XXXX, Newbern, Dansereau & Pitre 1999)
•
Arrive for sessions drug-free: clients who map miss fewer sessions and have
fewer positive urinalysis tests for opiates or cocaine (Czuchry, Dansereau, Dees &
Simpson1995, Dansereau, Joe, Dees & Simpson 1996, Dansereau, Joe &
Simpson 1993, Joe, Dansereau & Simpson 1994, Dansereau, Joe & Simpson
1995, Dees, Dansereau & Simpson 1997).
After Treatment Outcomes (e.g. sober/drug-free, no arrests)
•
Clients who have mapped during treatment have fewer positive urinalysis tests
for opiates, less needle use, and less criminal activity (Pitre, Dansereau & Joe
1996, Joe, Dansereau & Simpson 1997).
39
Mapping Bibliography
Blankenship, J., Dansereau, D. F., & Simpson, D. D. (1999). Cognitive enhancements of readiness for
corrections-based treatment for drug abuse. The Prison Journal, 79(4), 431-445.
Collier, C. R., Czuchry, M., Dansereau, D. F., & Pitre, U. (2001). The use of node-link mapping in the
chemical dependency treatment of adolescents. Journal of Drug Education, 31(3), 305-317.
Czuchry, M., & Dansereau, D. F. (1999). Node-link mapping and psychological problems: Perceptions
of a residential drug abuse treatment program for probationers. Journal of Substance Abuse
Treatment, 17(4), 321-329.
Czuchry, M., & Dansereau, D. F. (2000). Drug abuse treatment in criminal justice settings: Enhancing
community engagement and helpfulness. American Journal of Drug and Alcohol Abuse, 26(4), 537552.
Czuchry, M. & Dansereau, D.F. (2003). A model of the effects of node-link mapping on drug abuse
counselling. Addictive Behaviors, 28(3), 537-549.
Czuchry, M., & Dansereau, D.F. (2003). Cognitive skills training: Impact on drug abuse counselling and
readiness for treatment. American Journal of Drug and Alcohol Abuse, 29(1), 1-18.
Czuchry, M., & Dansereau, D.F. (2004). The importance of need for cognition and educational
experience in enhanced and standard substance abuse treatment. Journal of Psychoactive Drugs,
36(2), 243-251.
Czuchry, M., Dansereau, D. F., Dees, S. D., Simpson, D. D. (1995). The use of node-link mapping in
drug abuse counselling: The role of attentional factors. Journal of Psychoactive Drugs, 27(2), 161-166.
Dansereau, D. F. (2005). Node-link mapping principles for visualizing knowledge and information. In
S. O. Tergan & T. Keller (Eds.). Knowledge and information visualization: Searching for synergies.
Heidelberg/New York: Springer Lecture Notes in Computer Science.
Dansereau, D. F., & Dees, S. M. (2002). Mapping Training: The transfer of a cognitive technology for
improving counselling. Journal of Substance Abuse Treatment, 22(4), 219-230.
Dansereau, D. F., Dees, S. M., Chatham, L. R., Boatler, J. F., & Simpson, D. D. (1993). Mapping new
roads to recovery: Cognitive enhancements to counselling. A training manual from the TCU/DATAR
Project. Fort Worth, TX: Institute of Behavioral Research, Texas Christian University.
Dansereau, D. F., Dees, S. M., Greener, J. M., & Simpson, D. D. (1995). Node-link mapping and the
evaluation of drug abuse counselling sessions. Psychology of Addictive Behaviors, 9(3), 195-203.
Dansereau, D. F., Dees, S. M., & Simpson, D. D. (1994). Cognitive modularity: Implications for
counselling and the representation of personal issues. The Journal of Counselling Psychology, 41(4),
513-523.
Dansereau, D. F., Joe, G. W., Dees, S. M., & Simpson, D. D. (1996). Ethnicity and the effects of
mapping-enhanced drug abuse counselling. Addictive Behaviors, 21(3), 363-376.
Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1993). Node-link mapping: A visual representation
strategy for enhancing drug abuse counselling. Journal of Counselling Psychology, 40(4), 385-395.
Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1995). Attentional difficulties and the effectiveness of
a visual representation strategy for counselling drug-addicted clients. International Journal of the
Addictions, 30(4), 371-386.
Dansereau, D.F., & Simpson, D.D. (2005). Brief Intervention – Mapping the journey: A treatment guide
book Fort Worth: Texas Christian University, Institute of Behavioral Research. Online:
[email protected]
Dansereau, D.F., & Simpson, D.D. (2006). Brief Intervention-Mapping organizational change: A
guidebook on program needs. Fort Worth: Texas Christian University, Institute of Behavioral Research.
Online www.ibr.tcu.edu.
Dees, S. M., & Dansereau, D. F. (2000). TCU guide maps: A resource for counselors. Fort Worth,
TX:Institute of Behavioral Research, Texas Christian University.
Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1994). A visual representation system for drug abuse
counselors. Journal of Substance Abuse Treatment, 11(6), 517-523.
Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping-enhanced drug abuse counselling:
Urinalysis results in the first year of methadone treatment. Journal of Substance Abuse Treatment,
14(2), 1-10.
40
Joe, G. W., Dansereau, D. F., Pitre, U., & Simpson, D. D. (1997). Effectiveness of node-link mappingenhanced counselling for opiate addicts: A 12-month follow-up. Journal of Nervous and Mental
Diseases, 185(5), 306-313.
Knight, D. K., Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1994). The role of node-link mapping in
individual and group counselling. The American Journal of Drug and Alcohol Abuse, 20, 517-527.
Knight, K., Simpson, D. D., & Dansereau, D. F. (1994). Knowledge mapping: A psychoeducational tool
in drug abuse relapse prevention training. Journal of Offender Rehabilitation, 20, 187-205.
Newbern, D., Dansereau, D. F., Czuchry, M., & Simpson, D. D. (2005). Node-link mapping in individual
counselling: Treatment impact on clients with ADHD-related behaviors. Journal of Psychoactive
Drugs,37(1), 93-103.
Newbern, D., Dansereau, D. F., & Pitre, U. (1999). Positive effects on life skills, motivation and selfefficacy: Node-link maps in a modified therapeutic community. American Journal of Drug and Alcohol
Abuse, 25, 407-423.
Pitre, U., Dansereau, D. F., & Joe, G. W. (1996). Client education levels and the effectiveness of nodelink maps. Journal of Addictive Diseases, 15(3), 27-44.
Pitre, U., Dansereau, D. F., Newbern, D. & Simpson, D. D. (1998). Residential drug-abuse treatment for
probationers: Use of node-link mapping to enhance participation and progress. Journal of Substance
Abuse Treatment, 15(6), 535-543.
Pitre, U., Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping techniques to improve
substance abuse treatment in criminal justice settings. Journal of Drug Issues, 27(2), 435-449.
Sia, T. L., Dansereau, D. F., & Dees, S. M. (2001). Mapping your steps: Twelve step guide maps. Fort
Worth: Institute of Behavioral Research, Texas Christian University.
Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of
Substance Abuse Treatment, 27, 99-121.
Simpson, D. D., & Joe, G. W. (2004). A longitudinal evaluation of treatment engagement and
recoverystages. Journal of Substance Abuse Treatment, 27, 89-97.
Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1995). Client engagement and change
during drug abuse treatment. Journal of Substance Abuse, 7(1), 117-134.
Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1997). Drug abuse treatment process
components that improve treatment. Journal of Substance Abuse Treatment, 14(6), 565-572.
41
Appendix 2:
Extra guide maps for enhancing assessment. See also www.ibr.tcu.edu
42
43
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
4. If I changed, my life would be better
because . . .
1. W hat is good about staying the same?
Why should I give up drugs?
3. If I changed, my life would be worse
because . .
2. W hat is bad about staying the same?
Problems in the past Current Problems
Problems that run
in the family
Diet & Exercise
MY
HEALTH
Weight Current Medication Tobacco
Alcohol
How useful was this map and discussion?
Not Useful 1–2 –3–4
–5–6 –7 –8–9 –10 Very Useful
Comments: 44
Things that scare me Things that worry me
What my friends
say about me
My mood is
usually…
MY
EMOTIONS
Problems that run
in the family
Things I do to cope with stress
How useful was this map and discussion?
Not Useful 1–2 –3–4
–5–6 –7 –8–9 –10 Very Useful
Comments: 45
M Y LIFE S TORY Age
to
NAME:
What were your family and living situation like?
What were the positive & negative consequences of this?
DATE: /
/
What important events
happened in your life? Positive
Negative
How did you spend your time?
Who did you spend time with?
What were they like?
What experiences did you have around drugs, alcohol or
nicotine?
What were you like? How did you feel about yourself and life?
Did you get into trouble? If so, what kind?
Looking back, is there anything that you are particularly
proud of or happy about?
Is there anything that you regret or feel guilty about?
46
47
How useful was this map and discussion?
Not useful…1-2-3-4-5-6-7-8-9-10…Very useful
Comments:
Client’s Name:
M y S ocial N etwork
Peer Inventory
Peer Inventory
People who are
important to
me: What makes this
person important
to me?
How useful was this map and discussion?
Not Useful 1 –2–3 –4 –5–6 –7 –8–9
–10 Very Useful
Comments:
How will this person
be supportive of me ?
Client Name: Keyworker:
Date: /
/
48
Client:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
WORK
Haven’t worked since 17
Would like to do catering job
Need to earn money to pay off
debts
HEALTH
Not good health recently
DVT in right leg at start of
Xmas
Scared of hospital
INTERESTS
Don’t have any
FRIENDS
All friends using Heroin,
Crack and Cannabis
Lost all non-using friends –
they got fed-up with me
Family Health Emotional Interests Education Fun Work Friends
Areas to consider:
FUN
Don’t have any
Date: __/__/__
Upset for mum as lost her husband
Grieving for stepdad – he died suddenly at family
home
Didn’t find out until 2 days after as was at crack
house – feel guilty
EMOTIONAL
Keyworker:
Me
Today
Close to mum – always there for me
Not close to brothers or sisters
Owe family money
Me and youngest brother use together when we meet
Want to see daughter but only when clean
FAMILY
Map 1.1 ‘Me Today’
Appendix 3:
Worked examples:
49
Client Name: JANE JONES Keyworker : DARREN
WRIGHT Date: / / Severity of substance
abuse Heroin use has
increased since step- dad’s death. Now
£40/day
Treatment efforts to date
Treated with Methadone in
2004, but went to prison
after 2 months
Had treatment from DSB
in 2006 for 6 months.
Didn’t attend keyworker
appointmants
Map 1.2
Assessment
Feedback
Education, work,
offending history Left school at 15 and
no qualifications
Injecting
No benefits, and sex
work and shoplifting
to get by
Crack use increasing
– nearly every day
Would like to do
catering course
Current
Problems and
Resources
Emotions/
temperament Low in mood and
tearful most days.
Hasn’t- got over death
of step father a year
ago
Never had any
treatment for this
Mother’s support
Loyal
No drug -free friends.
Mum is supportive, but
not coping with
husband’s death
No contact with Sisters
Housing and basic needs
Major strengths Social support, family
One bedroom council flat
is ok, but in rent arrears.
Would need bigger place if
she is going to get
daughter back
Prepared to work hard
Youngest brother uses
heroin
Possible challenges
Large debts may
mean loss of flat and
need for continuing
crime Low mood
How useful was this map and discussion?
Not Useful 1 – 2–3–
4 –5 –6 –7 –8 –9–1 0 Very Useful
Comments: 50
Map 1.3 Things I would like to change Describe what you want to
change
How would life be different if
it happened
Stop using heroin and crack
Healthier, more money, could
see my daughter
Sort my debts out (Use back if needed)
How useful was this map and discussion?
Not Useful 1 –2–3 –4–5–6 –7–8
–9 –1 0 Very Useful
Comments: Will keep my flat, won’t have
to work on the streets, could
face my family again Client Name: JANE JONES Keyworker: DARREN WRIGHT
Date: /
/
51
Client Name: Keyworker :
Date: /
/ Map 1.4
Strengths
Health and physical
Apart from the DVT I
have not had major
problems
Problem solving/
coping Social relationships
I am close to my
mum, and I have tried
to support her in the
past year
I have coped with a lot
of problems in my life
I don’t like to rely on
others
I like to help others
What are your
strengths?
Emotions/
temperament When I am not using
I can be strong for
others
Values and beliefs
You should try to look
after your family
Tell the truth
Work or skills
I don’t mind hard
work
Client Name: JANE JONES How useful was this map and discussion?
Not Useful 1 – 2–3–
4 –5 –6 –7 –8 –9–1 0 Very Useful
Comments: Keyworker: DARREN WRIGHT
Date: /
/
52
53
5
Exercise
8
2
Money
Legal &
crime
3
5
4
4
Job/
Education
Housing
(Partner or family)
Relationships
Social life &
friends
(physical &
mental)
4
3
Drug and/or
alcohol use
Health
Satisfaction
out of 10
Keyworker: D. WRIGHT
In court for shoplifting – hope to get a treatment order. This
will stop if I get off the drugs.
Don’t get much, but not bothered about it. Would like to go
swimming again.
I owe so many people I have lost track – gas, electricity, rent,
family
Would like to work. I am interested in job in catering, but
can’t see how I can get the qualifications.
Flat is ok, but might get evicted if I don’t pay rent
Always end up using when I see my youngest brother. Want
to see my daughter but need to get clean first.
1st
2nd
I am struggling to deal with the death of my step-dad and
the guilt that I feel. I might get another DVT
All my friends that don’t use drugs have got fed up with me
3rd
I don’t drink at all, but I am injecting heroin every day and
using crack 3 times per week
Priority
Date: __/__/__
What would have to change to increase my score out
of 10?
Client: JANE JONES
Problem
Area
Goal Planner
54
Client Signature:
I am injecting heroin every day, and
using crack 3 times per week.
I am struggling to deal with the death of
my step dad and the guilt that I feel.
I owe so many people money that I have
lost track.
I owe gas and electricity
Describe the problems
Client Name:
Jane Jones
_________________
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Drug Use
Emotions
Money
PROBLEM
AREAS
Sheet Number:
Care Plan
Date:07/02/08
Key worker Signature:
2. Complete BTEI Getting Motivated to
Change package – by end of March
2008
1. Continue to keep drug use diary –
now prescribed
2.
Keep diary of how I am feeling
Meet with Housing Officer again to
finalise re-payment arrangements
.Referral to DRR Team Counsellor
3.
1.
Bring in benefits application form
to complete with key worker
Go to see debt counselling agency –
by end of February 2008
2.
1.
Goals for tackling these problems and
dates for achieving them
Assessor Name:
Darren Wright
55
Go to the appointment
Bring benefits application form to next key working session
Arrange another meeting with Council housing Officer
3.
4.
5.
What if I don’t understand what they tell me?
3.
Comments
I am worried that I will forget about the
appointment
2.
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
I get nervous speaking to officials over the
telephone
Complete Important Conversation Map with key
worker before call
Make call during my drug work session
Pin reminder to the fridge and ask worker to call
and remind me
Take someone with me – ask mum tonight
2.
3.
4.
Solutions
Keep reminding myself
that want to get my life
back
Strengths you
have or need
End of February 2008
8th February 2008
End of February 2008
End of February 2008
End of February 2008
When
Date: 05/02/08_
1.
To sort my
debts out
1.
Possible Problems
I met with my housing officer and
that went better than I thought
My mum is really good at this sort
of thing
MY GOAL
Call the agency and make an appointment
2.
Helpful people
& useful thoughts
Find phone number for local debt counselling agency
Specific Actions
Client Name: Jane Jones
1.
Care Plan Goals
56
To continue to collect my daily prescription
2.
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments
MY GOAL
Complete Important Conversation Map with key
worker in order to look at how I can resist pressure
from friends
Solutions
I will need to be strong
I am attending all my
appointments
Strengths you
have or need
Ongoing
From now until next
appointment
When
Date: 05/02/08_
package – by end of March 2008
2. Complete BTEI Getting Motivated to Change
1.
To stop injecting
and reduce my
drug use
1. What if I bump into My drug using friends as
they don’t want me to stop injecting because they
all do
Possible Problems
I want to do this as then I may get to
see my daughter again
Drug worker
My mum
Helpful people
& useful thoughts
To smoke Heroin rather than inject
Specific Actions
Client Name: Jane Jones
1.
Care Plan Goals